| NPI | 1689717712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ MA 55248) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 1753091) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2021-11-02 |