| NPI | 1588623631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA05916500) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 1860001-1) |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2007-07-08 |