| NPI | 1740711647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: CA A159638) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A159638) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2023-06-07 |