| NPI | 1790955094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX S6120) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301095475) |
| 207W00000X Ophthalmology (Licence: FL ME105560) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME105560) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: TX S6120) | |
| 207W00000X Ophthalmology (Licence: NY 254811) | |
| 207W00000X Ophthalmology (Licence: KY 49141) | |
| 207W00000X Ophthalmology (Licence: PA MD438233) | |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2024-06-12 |