| NPI | 1568678647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60218120) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 57011856) |
| 207W00000X Ophthalmology (Licence: IN 01068063A) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2023-05-15 |