| NPI | 1053949966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MT220301) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: PA MT220301) |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2024-05-07 |