| NPI | 1164502605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 248376) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CT 047083) |
| 174400000X Specialist (Licence: OH 35.84423) | |
| 207W00000X Ophthalmology (Licence: NJ 25MA08633500) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2015-04-02 |