| NPI | 1972713683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MB09214800) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA OS015106) |
| 207W00000X Ophthalmology (Licence: TX TEMPORARY/PENDING #) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: PA OS015106) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2022-02-13 |