| NPI | 1063414589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 154517) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 154517) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2007-07-08 |