| NPI | 1114345634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101269936) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101269936) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2021-01-11 |