| NPI | 1104051911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 312258) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD451477) |
| Enumeration Date | 2009-05-22 |
| Last Update Date | 2023-04-21 |