| NPI | 1003170366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO Dr.0061258) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: CO DR.0061258) |
| Enumeration Date | 2012-07-01 |
| Last Update Date | 2020-02-22 |