| NPI | 1780626986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD437604) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD26595) |
| 207W00000X Ophthalmology (Licence: CA A101572) | |
| 207W00000X Ophthalmology (Licence: NJ 25MA08624900) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2010-06-10 |