| NPI | 1457761850 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA10755900) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DE C1-0012776) |
| 207W00000X Ophthalmology (Licence: PA MD464753) | |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2023-01-20 |