| NPI | 1619234077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA10228900) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 256408) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2021-08-16 |