| NPI | 1720473689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD473979) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 296630) |
| 207W00000X Ophthalmology (Licence: NJ 25MA10742800) | |
| 207W00000X Ophthalmology (Licence: DE C1-0024592) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2022-08-19 |