| NPI | 1215959622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MAO6539000) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD064657L) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2013-08-27 |