| NPI | 1205839552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: OH 35.060285) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35060285) |
| 207W00000X Ophthalmology (Licence: WV 18631) | |
| 207W00000X Ophthalmology (Licence: PA MD057570L) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: PA MD057570L) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2021-05-24 |