| NPI | 1033104518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35038419) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35038419c) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2020-01-09 |