| NPI | 1336162122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301095698) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35-043259) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2015-11-10 |