| NPI | 1053679886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MT 60990) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA ML.60383942) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: AZ 51780) | |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2018-11-13 |