| NPI | 1912985102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0109X Ophthalmology Neuro-ophthalmology (Licence: DE C1-004091) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: DE C1-004091) |
| 207W00000X Ophthalmology (Licence: DE C1-004091) | |
| 2083A0100X Preventive Medicine Aerospace Medicine (Licence: DE C1-004091) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2023-05-11 |