| NPI | 1548647928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101272590) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC MTL003943) |
| 207W00000X Ophthalmology (Licence: KY 52826) | |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2021-07-08 |