| NPI | 1639173123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 208452) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA07699200) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA07699200) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 208452) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2009-06-25 |