| NPI | 1174083729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA12253400) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD481216) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-07-02 |