| NPI | 1124077359 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: TN 65583) | 
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME118634) | 
| 207W00000X Ophthalmology (Licence: LA 304969) | |
| 207W00000X Ophthalmology (Licence: TN 65583) | |
| 207W00000X Ophthalmology (Licence: AL 28562) | |
| Enumeration Date | 2006-05-06 | 
| Last Update Date | 2025-09-30 |