| NPI | 1528057890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 21749) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 9601270) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: SC 21749) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2025-01-23 |