| NPI | 1124682158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101285540) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 36405) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MD D0103123) | |
| 207W00000X Ophthalmology (Licence: DC MD600003650) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MI EMC0009476) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: WV 36405) | |
| 207W00000X Ophthalmology (Licence: MD D0103123) | |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2026-05-14 |