| NPI | 1437151719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 30914) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 30914) |
| 207W00000X Ophthalmology (Licence: OH 35.067760) | |
| 174400000X Specialist (Licence: OH 35-06-7760-B) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2018-09-18 |