| NPI | 1215228036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2022-00189) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD457242) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: KY 51521) | |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2022-04-06 |