| NPI | 1104454164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: PA MD493792) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: WV 36460) |
| 207W00000X Ophthalmology (Licence: TX V0115) | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2026-05-05 |