| NPI | 1821093626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX D6429) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX D6429) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2021-01-04 |