| NPI | 1679570675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: KY 17380) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 17380) |
| 207W00000X Ophthalmology (Licence: KY 17380) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2019-08-26 |