| NPI | 1053397752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: UT 169319-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 1693191205) |
| 207W00000X Ophthalmology (Licence: UT 169319-1205) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2018-02-05 |