| NPI | 1063704898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: GA 078790) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 078790) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2018-03-13 |