| NPI | 1225492028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.142713) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY R4138) |
| 207W00000X Ophthalmology (Licence: MN 67912) | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2021-11-11 |