| NPI | 1790797793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D89540) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101056974) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: DC MD037775) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2020-07-01 |