| NPI | 1003841479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA04312900) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 154513-1) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2009-12-30 |