| NPI | 1790710572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD452709) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 63772) |
| 207W00000X Ophthalmology (Licence: VA 0101235261) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-12-08 |