| NPI | 1487097341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.133062) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 54052) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2020-07-01 |