| NPI | 1578546917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MA 150972) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 150972) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2021-12-20 |