| NPI | 1902054406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101243947) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA 141432) |
| 207W00000X Ophthalmology (Licence: IL 036.144416) | |
| 207W00000X Ophthalmology (Licence: NM MD2020-0969) | |
| 207W00000X Ophthalmology (Licence: FL ME102245) | |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2021-07-13 |