| NPI | 1114156775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A120364) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 253944) |
| Enumeration Date | 2009-07-03 |
| Last Update Date | 2022-01-24 |