| NPI | 1053613844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35123459) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.018249) |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2014-05-12 |