| NPI | 1700085248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX P2061) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA R-7994) |
| 207W00000X Ophthalmology (Licence: IA 38879) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: TX P2061) | |
| Enumeration Date | 2007-07-14 |
| Last Update Date | 2022-11-03 |