| NPI | 1083656334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ID M-8696) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: ID M-8696) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2019-02-09 |