| NPI | 1922088673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 23237) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA 36792) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: NE 23237) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2019-04-11 |