| NPI | 1174524771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD020547E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA03043200) |
| 207W00000X Ophthalmology (Licence: NY 229001) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2007-07-23 |