| NPI | 1912107863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD441992) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MT190293) |
| 282N00000X General Acute Care Hospital (Licence: PA MT190293) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2015-11-19 |