| NPI | 1578544862 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 226224) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101234485) |
| 207W00000X Ophthalmology (Licence: DC MD037768) | |
| 207W00000X Ophthalmology (Licence: MD D0068111) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2011-06-21 |