| NPI | 1508832981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: OH 35066402) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35066402) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2017-04-05 |