| NPI | 1386932069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: PA MD461099) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA 136771) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: OH 35130823) | |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2019-06-03 |