| NPI | 1255323580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ MA053905) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 1817481) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2023-12-21 |