| NPI | 1821147778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX N5007) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NE 23961) |
| 207W00000X Ophthalmology (Licence: NM MD2021-0139) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2021-05-13 |