| NPI | 1568418523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101269774) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.087751) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2020-09-18 |