| NPI | 1730153461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA05731100) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD045438L) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NJ 25MA05731100) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2018-01-08 |