| NPI | 1497759229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: WV 18154) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: KY 30257) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: OH 35094593) | |
| 208600000X Surgery (Licence: WV 18154) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2021-05-06 |