| NPI | 1588645550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 113041) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 32123) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2007-07-08 |