| NPI | 1821369240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301117083) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI MT207072) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: MI 4301117083) | |
| Enumeration Date | 2012-01-17 |
| Last Update Date | 2021-03-09 |