| NPI | 1902849615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MT184531) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD424010) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2007-07-08 |