| NPI | 1538115480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35-047795) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 24489) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2009-03-30 |