| NPI | 1750345443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 9501152) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 9501152) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NC 9501152) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2023-07-20 |