| NPI | 1154404614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC TL33174) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA03340200) |
| 208600000X Surgery (Licence: NJ 25MA03340200) | |
| 208600000X Surgery (Licence: SC TL33174) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2010-11-10 |