| NPI | 1881691327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: OH 35052646) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35052646) |
| 207W00000X Ophthalmology (Licence: PA MD417521) | |
| 207W00000X Ophthalmology (Licence: NC 30488) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NC 30488) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: PA MD417521) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2021-01-13 |