| NPI | 1629015284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NM MD2007-0210) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 8620) |
| 207W00000X Ophthalmology (Licence: CA G50285) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2007-07-08 |