| NPI | 1588815468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX P9726) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 45124) |
| 207W00000X Ophthalmology (Licence: OH 35.098894) | |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2021-03-19 |