| NPI | 1366441446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 350662455) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 17672) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2014-09-04 |