| NPI | 1588624852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A155228) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD068046L) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2020-03-19 |