| NPI | 1881648038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX M9977) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101237522) |
| 207W00000X Ophthalmology (Licence: MD D0062707) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: TX m9977) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2017-03-27 |