| NPI | 1154854990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY TP035) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: NC 2023-00697) |
| 207W00000X Ophthalmology (Licence: KY 55414) | |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2023-09-14 |