| NPI | 1417939802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 178042-8) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 1780428) |
| Enumeration Date | 2005-11-19 |
| Last Update Date | 2010-06-08 |