| NPI | 1194915710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 67737) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: AZ 67737) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: IA MD-39182) | |
| 207W00000X Ophthalmology (Licence: IA 39182) | |
| 207W00000X Ophthalmology (Licence: TN 44844) | |
| 207W00000X Ophthalmology (Licence: FL ME140484) | |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2022-11-16 |