| NPI | 1093032435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 59501) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 46931) |
| 207W00000X Ophthalmology (Licence: OH 35123510) | |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2017-01-20 |