| NPI | 1083935498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY TP277) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35027547) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2021-07-14 |