| NPI | 1477998839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: MO 2018010581) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX Q9396) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2021-03-18 |