| NPI | 1609860766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 33335) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D0000064) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2013-07-11 |