| NPI | 1104852870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD478378) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A79800) |
| 207W00000X Ophthalmology (Licence: OH 35082112J) | |
| 207W00000X Ophthalmology (Licence: MD D76471) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2022-11-09 |