| NPI | 1891724217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: TX D5347) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX D5347) |
| 207W00000X Ophthalmology (Licence: FL ME23430) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2019-07-15 |