| NPI | 1649277351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA04623900) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD032701E) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2021-04-12 |