| NPI | 1740284579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: WV 20265) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 20265) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2021-05-06 |