| NPI | 1679542443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD022777E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DE C10004246) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2014-12-12 |