| NPI | 1982880605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: OH 35129264) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 64579) |
| 207W00000X Ophthalmology (Licence: MI 4301098040) | |
| 207W00000X Ophthalmology (Licence: NY 268617) | |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2021-04-30 |