| NPI | 1629450101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA10527800) |
| Additional Taxonomies | 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: NJ 25MA10527800) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2019-10-16 |