| NPI | 1275609596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101234554) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC MD34880) |
| 207W00000X Ophthalmology (Licence: MD D61620) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2021-06-14 |