| NPI | 1063749604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: MI 4301094251) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301094251) |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2024-09-25 |