| NPI | 1205824547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: MI 4301064466) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301064466) |
| 207W00000X Ophthalmology (Licence: CA G86170) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2018-09-19 |