| NPI | 1376579805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 099133) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO DR-43986) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2011-08-12 |