| NPI | 1235598087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.146052) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA LT000755) |
| 207W00000X Ophthalmology (Licence: MA 270680) | |
| 207W00000X Ophthalmology (Licence: NC 2018-00840) | |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2023-02-14 |