| NPI | 1477639292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ MA68525) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 154005) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2024-09-13 |