| NPI | 1962428276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 41415) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2005008908) |
| 207W00000X Ophthalmology (Licence: PA MD435175) | |
| 207WX0107X Ophthalmology Retina Specialist (Licence: AZ 41415) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2023-10-09 |