| NPI | 1366428120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: RI MD11942) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: RI MD11942) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MA 225844) | |
| 207W00000X Ophthalmology (Licence: MA 225844) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2017-04-06 |