| NPI | 1225020159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD428529) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 35997) |
| 207W00000X Ophthalmology (Licence: MD D0067362) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2023-11-21 |