| NPI | 1174840920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: KY 52803) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA MD-42794) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2019-08-26 |