| NPI | 1952517435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD445211) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301085608) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2012-09-10 |