| NPI | 1003949322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 156004) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ MA43221) |
| 208000000X Pediatrics (Licence: NY 156004) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2025-04-01 |