| NPI | 1659529055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: FL OS12479) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL OS12479) |
| 207W00000X Ophthalmology (Licence: MD H0074109) | |
| 207W00000X Ophthalmology (Licence: VA 0102203133) | |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2017-05-05 |