| NPI | 1497734958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 26232) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME56225) |
| 207W00000X Ophthalmology (Licence: IA MD-31125) | |
| 207W00000X Ophthalmology (Licence: AZ 16889) | |
| 207W00000X Ophthalmology (Licence: WI 37797) | |
| 207W00000X Ophthalmology (Licence: ND 14308) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2019-04-24 |