| NPI | 1760494835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101252785) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 058005) |
| 207W00000X Ophthalmology (Licence: MO 2010028292) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101252785) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2021-01-11 |