| NPI | 1023002193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AL 32023) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 216431) |
| 207W00000X Ophthalmology (Licence: FL ME104978) | |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2017-10-03 |