| NPI | 1487004396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN 68510) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 267753) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: OH 35.138594) | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2023-08-09 |