| NPI | 1275953846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA MD-45085) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX BP10053392) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: IA MD-45085) | |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2021-05-05 |