| NPI | 1538130042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 21108) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: NC 21108) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2021-03-29 |