| NPI | 1265485890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: OR MD21830) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: WA MD00044959) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2017-10-23 |