| NPI | 1871522359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 184997) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA06705900) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2007-09-06 |