| NPI | 1790814556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: KY 43642) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 43642) |
| 207WX0108X Ophthalmology, Uveitis and Ocular Inflammatory Disease (Licence: KY 43642) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2018-03-17 |