| NPI | 1154398253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: SC 17421) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 17421) |
| 207W00000X Ophthalmology (Licence: KY 32965) | |
| 207WX0107X Ophthalmology Retina Specialist (Licence: KY 32965) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2021-03-17 |