| NPI | 1740693936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: OH 35.148325) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 67049) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MN 67049) | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2023-06-08 |