| NPI | 1972560001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 287848) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A65415) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-10-01 |