| NPI | 1730153024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD035042E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA05475800) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2020-11-03 |