| NPI | 1912108432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301113410) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA08261200) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2022-07-21 |