| NPI | 1053529180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101248362) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101248362) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2021-06-22 |