| NPI | 1235111212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 19112) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 30240) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NE 19112) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2021-09-09 |