| NPI | 1124422175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: FL OS16652) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 5101024470) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MI 5101024470) | |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2023-03-22 |