| NPI | 1114210176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: CA A159100) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A159100) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2021-03-04 |