| NPI | 1023013190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD053800L) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NJ 25MA06114100) |
| 207W00000X Ophthalmology (Licence: DE C1005549) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2019-01-24 |