| NPI | 1134122948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35063695) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IN 01041459A) |
| 207W00000X Ophthalmology (Licence: MI 4301069901) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2012-05-10 |