| NPI | 1548603483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO DR.0061720) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA R-09892) |
| 207W00000X Ophthalmology (Licence: KY TP696) | |
| 207W00000X Ophthalmology (Licence: OH 35130694) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2023-03-04 |