| NPI | 1699719815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DE C1-0000715) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DE CI0000715) |
| 207W00000X Ophthalmology (Licence: NJ MA52946) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2015-06-08 |