| NPI | 1851395602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 9600893) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 1925301) |
| 207W00000X Ophthalmology (Licence: KY 31520) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2015-11-24 |