| NPI | 1407910748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD 60065638) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 2430221) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2014-10-01 |