| NPI | 1700278710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL OS14637) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: FL OS14637) |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2020-06-24 |