| NPI | 1770623126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D0043239) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC MD20629) |
| 207W00000X Ophthalmology (Licence: VA 0101058820) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2021-06-27 |