| NPI | 1407879638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 138663) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 138663) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2012-06-27 |