| NPI | 1558563601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301088489) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 57-013911) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2019-12-17 |