| NPI | 1508853821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: MA 210064) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 210064) |
| 207W00000X Ophthalmology (Licence: MA 210064) | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2017-04-12 |