| NPI | 1740206796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA06806900) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 202743-1) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2010-10-12 |