| NPI | 1275534919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00048909) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA07382200) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2017-07-21 |