| NPI | 1003890120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD051488L) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD051488L) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2009-09-16 |