| NPI | 1043409873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.097073) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 44434) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: OH 35.097073) | |
| 207WX0107X Ophthalmology Retina Specialist (Licence: KY 44434) | |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2017-04-04 |