| NPI | 1144325929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 154386) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CT 40481) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |