| NPI | 1518958842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 0026851) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 13516) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NC 0026851) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2021-01-28 |