| NPI | 1578564639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA SP165) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: IA SP165) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2021-03-30 |