NPI | 1912113069 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: OH 35-093313) |
Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY NY246050) |
207W00000X Ophthalmology (Licence: PA MT184274) | |
207W00000X Ophthalmology (Licence: OH 093313) | |
Enumeration Date | 2007-05-15 |
Last Update Date | 2020-03-25 |