| NPI | 1174519615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: DC MD14019) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D0047384) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2019-11-26 |