| NPI | 1851376776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 038552) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC MD19274) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: GA 038552) | |
| 207WX0107X Ophthalmology Retina Specialist (Licence: SC MD19274) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2024-06-18 |