| NPI | 1285811216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MA 250825) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 250825) |
| 207W00000X Ophthalmology (Licence: PA MD439612) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NH 15686) | |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2020-05-11 |