| NPI | 1497195267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD461967) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 06303) |
| 207W00000X Ophthalmology (Licence: NM RS2016-0706) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2019-01-15 |