| NPI | 1629269352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NM MD2011-0477) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD440113) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2023-10-18 |