| NPI | 1629005160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MI 4301406847) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35-06-3107) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2020-08-04 |