| NPI | 1952399958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA07829700) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 213551) |
| 207W00000X Ophthalmology (Licence: NY 234342-1) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2008-06-13 |