| NPI | 1811965288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DC MD11250) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 010133020) |
| 207W00000X Ophthalmology (Licence: MD D0026700) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2007-07-08 |