| NPI | 1063591402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D0089313) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 47737-020) |
| 207W00000X Ophthalmology (Licence: PA MD430918) | |
| Enumeration Date | 2006-11-05 |
| Last Update Date | 2021-01-05 |