| NPI | 1609842749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 165798) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MAO5288500) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2008-01-23 |