| NPI | 1992168652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 296005) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 69061) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2020-10-12 |