| NPI | 1376543157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA07962500) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD433922) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2021-04-12 |