| NPI | 1003870973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MA 160619) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 160619) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2017-04-12 |