| NPI | 1811176548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: OH 35120897) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.120897) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2018-12-04 |