| NPI | 1134515042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: SC 85225) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 85225) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: TN 59011) | |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2023-11-09 |