| NPI | 1790071694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101261451) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 26407) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MD D0082623) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2024-07-24 |