| NPI | 1831868512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301507161) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: MI 4301507161) |
| 207W00000X Ophthalmology (Licence: OH 35.143875) | |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2024-01-04 |