| NPI | 1114924701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD049152L) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ MA05909300) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2025-05-15 |