| NPI | 1528022464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301097516) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD031064E) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2010-10-15 |