| NPI | 1790804961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: AZ 29313) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 29313) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2018-10-30 |