| NPI | 1790071140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NM MD2016-0188) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD171553) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2024-04-19 |