| NPI | 1891913380 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: GA 062035) | 
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: SC 40446) | 
| Enumeration Date | 2007-04-23 | 
| Last Update Date | 2024-06-25 |