| NPI | 1750332532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA05273500) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD043560E) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2010-09-10 |