| NPI | 1245763390 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: OH 35.147162) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: PA MD480096) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2024-04-03 |