| NPI | 1013119262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KS 0436270) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT189966) |
| 207W00000X Ophthalmology (Licence: PA Mt189966) | |
| 207W00000X Ophthalmology (Licence: WI 55543-20) | |
| 207W00000X Ophthalmology (Licence: MO 2013006329) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MO 2013006329) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: KS 0436270) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2022-09-01 |