| NPI | 1689977720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD457707) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT197645) |
| 207W00000X Ophthalmology (Licence: NC 2014-01517) | |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2021-03-05 |