| NPI | 1386762128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: TX M6820) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX M6820) |
| 207WX0009X Ophthalmology Glaucoma Specialist (Licence: TX M6820) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2017-04-19 |