| NPI | 1356753883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA10328400) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD464705) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2018-07-31 |