| NPI | 1154685360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA 137160) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 267907) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2022-07-21 |