| NPI | 1164431490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 111093) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ MA033898) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2023-07-12 |