| NPI | 1861711558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC MD37781) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301096321) |
| 207W00000X Ophthalmology (Licence: NC 2015-00277) | |
| 207W00000X Ophthalmology (Licence: TN MD51142) | |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2023-06-27 |