| NPI | 1326488560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2017-00442) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 079821) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NC 2017-00442) | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2021-04-29 |