| NPI | 1942448618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DC MD040383) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35123368) |
| 207W00000X Ophthalmology (Licence: MD D73955) | |
| 207W00000X Ophthalmology (Licence: VA 0101251543) | |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2014-05-12 |