| NPI | 1730138595 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MN 52441) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IL 036-115343) |
| 207W00000X Ophthalmology (Licence: WI 45929) | |
| 207W00000X Ophthalmology (Licence: MN 52441) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2022-08-23 |