| NPI | 1023078821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: NC 9600016) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 9600016) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2020-11-17 |