| NPI | 1154456226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 240203) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: MA 240203) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2019-05-06 |