| NPI | 1881693059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA06097700) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 183273-1) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NJ 25MA06097700) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2022-03-23 |