| NPI | 1902260698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: PA MD477585) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: MI 4301501635) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2023-10-28 |