| NPI | 1720016215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 43010 43653) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: MI 4301043653) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2021-03-09 |