| NPI | 1376003145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 05527) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 34.016745) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2023-08-17 |