| NPI | 1104870401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: MD D0058150) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D0058150) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2021-03-08 |