| NPI | 1235315268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D0074142) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD445806) |
| 207W00000X Ophthalmology (Licence: WV 25131) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MD D0074142) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: PA MD445806) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: WV 25131) | |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2020-04-22 |