| NPI | 1962722173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D81570) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA MD-42741) |
| 207R00000X Internal Medicine (Licence: MA 244936) | |
| 207W00000X Ophthalmology (Licence: FL ME119582) | |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2016-06-06 |