| NPI | 1629074844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX L2390) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX L2390) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2021-05-06 |