| NPI | 1699902577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 51210) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: AZ 51210) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2022-01-26 |