| NPI | 1053315457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: GA 019156) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 019156) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2017-10-04 |