| NPI | 1972555142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NV 21154) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NM MD2012-0575) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2022-08-24 |