| NPI | 1417368648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 67470) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 279076) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: GA 92369) | |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2024-01-16 |