| NPI | 1962586073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD437353) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TN MD39738) |
| 207W00000X Ophthalmology (Licence: NJ 25MA08200800) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2009-08-08 |