NPI | 1740579531 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MO 2017008330) |
Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2017008330) |
Enumeration Date | 2011-03-31 |
Last Update Date | 2020-02-05 |