| NPI | 1912260381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: OR MD187027) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD457531) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2021-02-20 |