| NPI | 1104364256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: OH 34.015071) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 34.015071) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2022-06-30 |