| NPI | 1306341771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: VA 0101281213) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: PA MD477456) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2025-08-22 |