| NPI | 1750587119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD477494) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC MD038456) |
| 207W00000X Ophthalmology (Licence: MD D0067126) | |
| 207W00000X Ophthalmology (Licence: VA 0101243386) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2022-08-02 |