| NPI | 1659400208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 134945) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 134945) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2007-11-02 |