| NPI | 1700076783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX N2637) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX N2637) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2017-03-29 |