| NPI | 1982759221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 41066) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX M7299) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: AZ 41066) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2020-05-22 |