| NPI | 1700362522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: OK 39114) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.132491) |
| 207W00000X Ophthalmology (Licence: IA MD-45956) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: OK 34604) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: IA ND-45956) | |
| 207WX0110X Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist (Licence: IA MD-45956) | |
| Enumeration Date | 2018-07-15 |
| Last Update Date | 2022-07-18 |