| NPI | 1053454009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: NC 2013-01462) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301097455) |
| 207W00000X Ophthalmology (Licence: KY IP843) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2019-02-04 |