| NPI | 1881626497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 013948) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: LA 013948) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2017-04-07 |