| NPI | 1720009525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 138708) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME0058247) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2013-04-24 |