| NPI | 1215932843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD072346L) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 82044) |
| 207W00000X Ophthalmology (Licence: VA 0101056501) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: PA MD072346L) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2020-11-05 |