| NPI | 1790097350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD H71947) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0102202807) |
| 207W00000X Ophthalmology (Licence: PA OT012730) | |
| Enumeration Date | 2010-07-11 |
| Last Update Date | 2021-12-08 |