| NPI | 1639444904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 69149) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: WI 69149) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2023-03-07 |