| NPI | 1457686586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 254315) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.016146) |
| 207W00000X Ophthalmology (Licence: PA MT196557) | |
| 207W00000X Ophthalmology (Licence: DE C1-0010130) | |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2016-03-09 |