| NPI | 1720579394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: GA 97487) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC LL52345) |
| 207W00000X Ophthalmology (Licence: WA MD61264542) | |
| 208600000X Surgery (Licence: SC LL52345) | |
| Enumeration Date | 2018-05-19 |
| Last Update Date | 2023-12-05 |