| NPI | 1841540028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA 137097) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 164486) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2015-07-10 |