| NPI | 1831469881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: ND 17681) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D89489) |
| 207W00000X Ophthalmology (Licence: PA MD464443) | |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2022-01-04 |