| NPI | 1922116797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 093722) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 21054) |
| 207W00000X Ophthalmology (Licence: FL 20030) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2008-04-28 |