| NPI | 1285792747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 31403) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 105511) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2012-09-18 |