| NPI | 1073565487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: WY 8868A) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 30384) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2019-11-07 |