| NPI | 1073689253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101229044) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC MD15560) |
| 207W00000X Ophthalmology (Licence: MD D0054382) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2021-06-22 |