| NPI | 1578979712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: TN DO0000003174) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL OS154154) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2023-11-16 |