| NPI | 1124010913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA 26370) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: IA 26370) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2018-02-15 |