| NPI | 1649427899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO 0056737) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 23270) |
| 207W00000X Ophthalmology (Licence: MN 104986) | |
| 207W00000X Ophthalmology (Licence: MN 53468) | |
| 207W00000X Ophthalmology (Licence: PA MD445065) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2021-06-14 |