| NPI | 1508131954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: SC 40818) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301100350) |
| 207W00000X Ophthalmology (Licence: MI 4301100350) | |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2018-03-17 |