| NPI | 1720097157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MB04846500) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MB04846500) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2021-09-02 |