| NPI | 1639130529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 132294) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CT 045046) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2007-07-08 |