| NPI | 1023040714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA a87565) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 240221) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2012-03-01 |