| NPI | 1063040178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA12588400) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 328873) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-07-22 |