| NPI | 1487148243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MS 33128) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 5151009600) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MS 33128) | |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2024-07-10 |