| NPI | 1356343248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD029459E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA05273000) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2017-03-10 |