| NPI | 1578527461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35067856) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35067856) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2016-03-15 |