| NPI | 1336407253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.139689) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 183352) |
| 207W00000X Ophthalmology (Licence: GA 082089) | |
| 207W00000X Ophthalmology (Licence: CT 55897) | |
| Enumeration Date | 2012-04-28 |
| Last Update Date | 2022-03-17 |