| NPI | 1316930688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN MD68554) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO MD108395) |
| 207W00000X Ophthalmology (Licence: KS 0429147) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: KS 04-29147) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2024-05-15 |