| NPI | 1811347859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NH 22494) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301110500) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NH 22494) | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2022-09-07 |