| NPI | 1205043684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: OH 34.009294) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 58-001590) |
| 207W00000X Ophthalmology (Licence: FL OS10225) | |
| 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: FL OS10225) | |
| 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: PA OS014584) | |
| 207W00000X Ophthalmology (Licence: PA OS014584) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-08-19 |