| NPI | 1235126624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD024259E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DE C1-0007806) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2021-12-15 |