| NPI | 1962668046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DC 144107) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC MD038232) |
| 207W00000X Ophthalmology (Licence: GA 069515) | |
| 207W00000X Ophthalmology (Licence: TX n9470) | |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2014-02-03 |