| NPI | 1972594083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA06274100) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 1869411) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NJ 25MA06274100) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NY 186941-1) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2017-03-30 |