| NPI | 1902462047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101266811) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: NY 301299) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2020-04-17 |