| NPI | 1790769701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 108058) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: MO 108058) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2017-04-10 |