| NPI | 1972957975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX T8300) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX T8300) |
| 207W00000X Ophthalmology (Licence: MO 2020014577) | |
| Enumeration Date | 2016-04-16 |
| Last Update Date | 2023-05-26 |