| NPI | 1639271984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA04973100) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 165563) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2008-07-01 |