| NPI | 1659370633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD007479E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA04551300) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2008-07-02 |