| NPI | 1740456920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DC MD039349) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D0072186) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2019-02-08 |