| NPI | 1790931186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD451431) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2012009703) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2025-05-29 |