| NPI | 1518162247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: WI 57459020) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO 48790) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2023-09-21 |