| NPI | 1578556213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: LA MD13621R) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 13621R) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2017-06-07 |