| NPI | 1841269669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL 41148) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 132728) |
| 207W00000X Ophthalmology (Licence: VT 0420007916) | |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2011-11-03 |