| NPI | 1336131499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX L6300) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX L6300) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2017-04-25 |