| NPI | 1053687004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA10790600) |
| Additional Taxonomies | 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: PA MD463790) |
| 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: NJ 25MA10790600) | |
| 207W00000X Ophthalmology (Licence: PA MD463790) | |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2023-07-18 |