| NPI | 1326249889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 003086) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MT187242) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2018-09-07 |