| NPI | 1396159208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KS 04-42791) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301114302) |
| 207W00000X Ophthalmology (Licence: MO 2015021642) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MI 4301114302) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: KS 04-42791) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MO 2015021642) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2022-09-01 |