| NPI | 1518351493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2020-00983) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.135920) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2021-04-29 |