| NPI | 1508819301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2006-01284) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 29558) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: NC 2006-01284) | |
| 207WX0107X Ophthalmology Retina Specialist (Licence: SC 29558) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-01-06 |