| NPI | 1568426880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD020612E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35038231S) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2007-07-08 |