| NPI | 1225449317 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: LA 330501)  | 
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: MS 25063)  | 
| Enumeration Date | 2014-05-12 | 
| Last Update Date | 2022-12-09 |