| NPI | 1952941106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 11318011-1251) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: UT 11318011-1251) |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2021-11-18 |