| NPI | 1720015621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: WI 51404) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 51404) |
| 207W00000X Ophthalmology (Licence: TN MD40960) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2021-05-10 |