| NPI | 1306158381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101285734) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: MI 4301097034) |
| 207W00000X Ophthalmology (Licence: MI 4301097034) | |
| 207W00000X Ophthalmology (Licence: NM #MD2016-0138) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NM MD2016-0138) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2025-11-07 |