| NPI | 1205886421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 302336) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 010190T) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2023-05-01 |