| NPI | 1457342123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 142450-1) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: NY 142450-1) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2010-12-28 |