| NPI | 1457548497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 242414) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX N2925) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2019-01-03 |