| NPI | 1043691124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC MD83604) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35135824) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2024-10-07 |