| NPI | 1770643256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD013207E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA03417700) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2021-05-25 |