| NPI | 1134482466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101262610) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301100428) |
| 207W00000X Ophthalmology (Licence: KY TP945) | |
| 207W00000X Ophthalmology (Licence: OH 35128180) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2022-07-21 |