| NPI | 1396763652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO 34076) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: CO 34076) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2024-04-02 |