| NPI | 1336532944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL OS17421) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: PA OS019844) |
| 207W00000X Ophthalmology (Licence: PA OS019844) | |
| 207W00000X Ophthalmology (Licence: WV 3504) | |
| Enumeration Date | 2015-03-07 |
| Last Update Date | 2023-04-11 |