| NPI | 1497750673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 175307-1) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CT 038615) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2010-10-28 |