| NPI | 1497708184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D0068866) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DE TP-0003219) |
| 207W00000X Ophthalmology (Licence: DE C1-0008039) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2011-07-08 |