| NPI | 1306849716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D0044710) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101053846) |
| 207W00000X Ophthalmology (Licence: DC MD20175) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101053846) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: DC MD20175) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MD D0044710) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2020-09-28 |