| NPI | 1336791045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: IA MD-50985) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019026204) |
| 207W00000X Ophthalmology (Licence: MO 2020013956) | |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2023-07-07 |