| NPI | 1831361690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME127344) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MS 22805) |
| 207W00000X Ophthalmology (Licence: LA MD205040) | |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2020-06-01 |