| NPI | 1619137072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MN 58924) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: NE 25501) |
| 207W00000X Ophthalmology (Licence: NE 25501) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2023-04-26 |