| NPI | 1548722085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA12765800) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 95530) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2025-09-25 |