| NPI | 1033473913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NV 17065) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA 15241) |
| 207W00000X Ophthalmology (Licence: OH 128338) | |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2023-03-31 |