| NPI | 1861686545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 250306) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME 98592) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2024-01-16 |