| NPI | 1063603322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: AL 30080) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AL 30080) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2021-05-04 |