| NPI | 1235699323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: CA A185112) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 67739) |
| 207R00000X Internal Medicine (Licence: MN 30022) | |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2024-01-08 |