| NPI | 1164427308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: OR MD15274) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD15274) |
| 207W00000X Ophthalmology (Licence: WA MD00028055) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: WA MD00028055) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2021-04-02 |