| NPI | 1982674297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA 29715) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SD 4798) |
| 207W00000X Ophthalmology (Licence: NE 18333) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: IA 29715) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2023-11-21 |