| NPI | 1285675629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A89467) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 240037-1) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2022-12-04 |