| NPI | 1568464832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: OH 35.061194) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD66059L) |
| 207W00000X Ophthalmology (Licence: OH 35061194) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2021-05-24 |