| NPI | 1043553332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD460748) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA10573900) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2020-11-03 |