| NPI | 1407210057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2020-00126) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: NC 2020-00126) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2023-01-10 |