| NPI | 1790830032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX M6622) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NM MD2009-0622) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2018-03-17 |