| NPI | 1457606816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 80132) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA mt201514) |
| 207W00000X Ophthalmology (Licence: KY 49353) | |
| 207W00000X Ophthalmology (Licence: OH 35128577) | |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2023-03-22 |