| NPI | 1619974862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: LA 010425) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 010425) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2020-01-15 |