| NPI | 1639112097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA04054400) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ ma40544) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2024-11-27 |