| NPI | 1083173280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: DC CS2100012920) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101285962) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MD D0103392) | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2025-08-29 |