| NPI | 1679558357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MS 28079) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AL 17963) |
| 207W00000X Ophthalmology (Licence: MS 28079) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2020-11-04 |