| NPI | 1104907963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 256635) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 058611) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2011-03-15 |