| NPI | 1366475378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101256812) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 194774) |
| 207W00000X Ophthalmology (Licence: OH 35.135629) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2021-07-19 |