| NPI | 1487880274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 59627) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME119295) |
| 207W00000X Ophthalmology (Licence: TX P6116) | |
| 207W00000X Ophthalmology (Licence: WI 55730) | |
| 207W00000X Ophthalmology (Licence: IA MD-43103) | |
| 207W00000X Ophthalmology (Licence: HI MDR-5720) | |
| Enumeration Date | 2009-06-07 |
| Last Update Date | 2019-08-12 |