| NPI | 1609254812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 60202) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC MD047084) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2020-07-30 |