| NPI | 1306992003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN 45994) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: TN 45994) |
| 207W00000X Ophthalmology (Licence: AL 26155) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2021-11-11 |