| NPI | 1679756019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: UT 86158471205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 86158471205) |
| 207W00000X Ophthalmology (Licence: FL ME109701) | |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2023-08-16 |