| NPI | 1336409051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: LA 308544) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX Q8772) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2019-05-16 |