| NPI | 1205839453 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OH 35-03-0075) |
| Additional Taxonomies | 156FX1100X Technician/Technologist, Ophthalmic (Licence: OH 35-03-0075) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2012-09-13 |