| NPI | 1922075076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA MD-41758) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 26368) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: IA 41758) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2019-01-29 |