| NPI | 1578527396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: PR 13255) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PR 13255) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2017-04-05 |