| NPI | 1356385876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 31603) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35075483) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-04-03 |