| NPI | 1730132242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MI 4301076657) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35088233) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: OH 35088233) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2023-11-03 |