| NPI | 1699902346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX Q1008) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301109051) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: MI 4301109051) | |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2021-12-29 |