| NPI | 1063673408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA09305700) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX P2684) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2013-07-10 |