| NPI | 1568510675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD431150) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 6253) |
| 207W00000X Ophthalmology (Licence: DE C1-0008886) | |
| 207W00000X Ophthalmology (Licence: NJ 25MA08470400) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2021-08-30 |