| NPI | 1982911723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101250905) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD477446) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0101250905) | |
| 208D00000X General Practice (Licence: VA 0101250905) | |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2023-01-19 |