| NPI | 1134757479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME176964) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D0099545) |
| 207W00000X Ophthalmology (Licence: DC MD500002845) | |
| 207W00000X Ophthalmology (Licence: VA 0101281391) | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2026-07-20 |