| NPI | 1437360351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA 39020) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME101982) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: IA 39020) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2018-02-15 |