| NPI | 1922269760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A122718) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 261683) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2013-08-13 |