| NPI | 1720032832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DE C1-0007995) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 232178-1) |
| 207W00000X Ophthalmology (Licence: PA MD 064397L) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2011-08-19 |