| NPI | 1467493718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA07781300) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD 424214) |
| 207W00000X Ophthalmology (Licence: WI 44604-020) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2010-07-27 |