| NPI | 1336131440 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD025102E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35051317M) |
| 207W00000X Ophthalmology (Licence: NY 1311371) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2023-03-07 |