| NPI | 1376583112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 12615) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35027971) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2021-05-06 |