| NPI | 1710412671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MI 4301111662) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301111662) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2018-01-08 |