| NPI | 1023066578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: FL ME149069) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NV 13099) |
| 207W00000X Ophthalmology (Licence: WA MD00046436) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2022-11-08 |