| NPI | 1306899059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DE C1-0004143) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DE C10004143) |
| 207W00000X Ophthalmology (Licence: PA MD052008L) | |
| 207W00000X Ophthalmology (Licence: NJ MA61249) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2014-09-20 |