| NPI | 1154595171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: CO 49167) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO 0049167) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2020-03-11 |