| NPI | 1023009131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA05203100) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 2210151) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2017-04-24 |