| NPI | 1003976416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301074191) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: MI 4301074191) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2021-03-09 |