| NPI | 1710206719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: AL 33279) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AL 33279) |
| Enumeration Date | 2010-05-31 |
| Last Update Date | 2019-10-18 |