| NPI | 1568420818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD016487E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25Ma04028100) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2007-07-31 |