| NPI | 1003017468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 66645) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 57009416) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2015-05-28 |