| NPI | 1407953540 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA07390400) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 219026) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-06-19 |