| NPI | 1871503409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD063045L) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301071564) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2021-08-06 |