| NPI | 1245390749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD MD31607) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101059098) |
| 207W00000X Ophthalmology (Licence: DC D53628) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2021-11-22 |