| NPI | 1407261183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD478391) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 292300) |
| Enumeration Date | 2014-06-21 |
| Last Update Date | 2022-11-02 |