| NPI | 1407234123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD476232) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2020-00409) |
| 207W00000X Ophthalmology (Licence: OH 35.135734) | |
| 207WX0107X Ophthalmology Retina Specialist (Licence: PA MD476232) | |
| 207WX0108X Ophthalmology Uveitis and Ocular Inflammatory Disease (Licence: PA MD476232) | |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2022-08-17 |