| NPI | 1710981246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101056722) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 9800004) |
| 174400000X Specialist (Licence: VA 0101056722) | |
| 207W00000X Ophthalmology (Licence: VA 0101056722) | |
| 207W00000X Ophthalmology (Licence: NC 9800004) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NC 9800004) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2017-05-15 |