| NPI | 1780995993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60625861) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA MD-41651) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2016-07-11 |