| NPI | 1619179264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MD D70641) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D70641) |
| 207W00000X Ophthalmology (Licence: PA MD-488732) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: PA MD-488732) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2025-07-16 |