| NPI | 1215930805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: SC 36080) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101223022) |
| 207W00000X Ophthalmology (Licence: SC 36080) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2017-04-04 |