| NPI | 1205094208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD450629) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT193104) |
| 207W00000X Ophthalmology (Licence: MI 4301100103) | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2018-06-06 |