| NPI | 1104899186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD009276E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ MA04747900) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2016-12-02 |