| NPI | 1447516133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 57747) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301109274) |
| 207W00000X Ophthalmology (Licence: PA MD464124) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: AZ 57747) | |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2023-03-07 |