| NPI | 1710180534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: WV 22199) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: OH 35093192) |
| 208600000X Surgery (Licence: WV 22199) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2021-05-06 |