| NPI | 1518173939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A96015) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.089728) |
| 207W00000X Ophthalmology (Licence: KY 41111) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2009-06-03 |