| NPI | 1023019171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA04964000) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 158611-1) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2022-08-06 |