| NPI | 1619165891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 24404) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA02440400) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2009-03-04 |