| NPI | 1265403810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 24147) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35046757) |
| 207W00000X Ophthalmology (Licence: MT MED-PHYS-LIC-27425) | |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2017-03-31 |