| NPI | 1013990027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD204340) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NM MD2020-0577) |
| 207W00000X Ophthalmology (Licence: CA C52689) | |
| 207W00000X Ophthalmology (Licence: OH 092756) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2021-12-13 |