| NPI | 1528064912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD042632L) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 23247) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2010-03-19 |