| NPI | 1700017902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DE C2-0009503) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA OS014823) |
| 207W00000X Ophthalmology (Licence: NJ 25MB08585000) | |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2010-10-26 |