| NPI | 1457306995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: WI 42008) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA 146607) |
| 207W00000X Ophthalmology (Licence: WI 42008) | |
| 207W00000X Ophthalmology (Licence: IA 32620) | |
| 207W00000X Ophthalmology (Licence: MN 64260) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2021-05-10 |