| NPI | 1528061876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60275755) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NM MD2006-0840) |
| 207W00000X Ophthalmology (Licence: OH 35040894) | |
| 207W00000X Ophthalmology (Licence: PA MD040856E) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2019-03-15 |