| NPI | 1396807905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA08681500) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 226583) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2011-10-05 |