| NPI | 1578691515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME117170) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.093559) |
| 207W00000X Ophthalmology (Licence: MD D0065667) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2022-07-07 |