| NPI | 1386762227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MN 61616) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2007-00903) |
| 207W00000X Ophthalmology (Licence: MI 4301082323) | |
| 207W00000X Ophthalmology (Licence: WI 54273) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2019-05-29 |