| NPI | 1679816326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA09867700) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NH 18744) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2023-06-22 |