| NPI | 1659378248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ MA06022300) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD062901L) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2023-01-09 |