| NPI | 1023073459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: UT 7161573-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 1352-TEP) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2018-06-28 |