| NPI | 1235340522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 28330) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 42480) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NE 28330) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2019-04-16 |