| NPI | 1215134176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO DR.0051055) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: CO DR.0051055) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2021-01-29 |