| NPI | 1174525067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD022592E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA05348400) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2020-01-22 |