| NPI | 1205167657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 071894) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 259551-1) |
| 207W00000X Ophthalmology (Licence: NC 2013-00925) | |
| Enumeration Date | 2010-01-26 |
| Last Update Date | 2022-02-02 |