| NPI | 1295058790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: SC 87451) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301095784) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: GA 94696) | |
| 207W00000X Ophthalmology (Licence: NC 201802495) | |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2025-11-25 |