| NPI | 1386645620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: MN 48034) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD421764) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2020-03-17 |