| NPI | 1982138400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 318958) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 318958) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2023-07-17 |