| NPI | 1982678223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101052712) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D0047789) |
| 207W00000X Ophthalmology (Licence: DC MD21418) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MD D0047789) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: DC MD21418) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101052712) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2021-04-27 |