| NPI | 1982800470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: OR MD161778) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 25649) |
| 207W00000X Ophthalmology (Licence: WA 60335872) | |
| 207W00000X Ophthalmology (Licence: IA 39381) | |
| 207W00000X Ophthalmology (Licence: OR 161778) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: WA MD60335872) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2021-04-02 |