| NPI | 1700051919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 261929) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD60079336) |
| 207W00000X Ophthalmology (Licence: CA A95877) | |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2013-01-15 |