| NPI | 1477550002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD055909L) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ MA06287800) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2008-02-07 |