| NPI | 1609862846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD153855) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301077983) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2018-12-30 |