| NPI | 1235592445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ND 18341) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 6574-851) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: CA A168668) | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2022-08-16 |