| NPI | 1740675636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MI 4301504678) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: CO 61924) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2021-08-29 |