| NPI | 1104800143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 184083-1) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA06584600) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2007-09-26 |