| NPI | 1548255631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA04065200) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD034605E) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2012-03-22 |