| NPI | 1659377729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA04622600) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA G47368) |
| 207W00000X Ophthalmology (Licence: MI 4301046768) | |
| 207W00000X Ophthalmology (Licence: PA MD022254E) | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2010-07-27 |