| NPI | 1215021118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 155196) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 340052) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2025-06-26 |