| NPI | 1669436440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA04990800) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD034647E) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2008-03-14 |