| NPI | 1215936380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD034158E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA05492400) |
| 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: PA MD034158E) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2020-09-02 |