| NPI | 1609004308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 46137) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.128411) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: KY 46137) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: OH 35.128411) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2018-11-28 |