| NPI | 1710111224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: ID M12830) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ID M-12830) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2020-11-05 |