| 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 |