| NPI | 1073553707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 029656) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 154953) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2024-04-02 |