| NPI | 1124237300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX N9336) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: TX N9336) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2022-01-11 |