| NPI | 1700874740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD056677L) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA06125800) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2020-04-21 |