| NPI | 1134219801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ME 24367) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO 43728) |
| 207W00000X Ophthalmology (Licence: WA MD60035767) | |
| 207W00000X Ophthalmology (Licence: NY 259317) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2023-03-07 |