| NPI | 1326071648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2018-02030) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.086275) |
| 207W00000X Ophthalmology (Licence: WV 24355) | |
| 208000000X Pediatrics (Licence: OH 35-08-6275) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2019-07-02 |