| NPI | 1912936691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD012750E) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: PA MD012750E) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2015-06-01 |