| NPI | 1821075664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: TX H4498) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX H4498) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2024-01-03 |