| NPI | 1104870427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA08228100) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA08228100) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2015-01-04 |