| NPI | 1629009576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 237264) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA07982400) |
| 207W00000X Ophthalmology (Licence: CT 043661) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2008-12-08 |