| NPI | 1831372499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A82525) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX 8256873-1205) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: TX 8256873-1205) | |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2023-05-03 |