| NPI | 1184675100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101268576) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ND 11985) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: ND 11985) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2020-07-01 |