| NPI | 1598747792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 30910) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35 06 2541 A) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2021-12-10 |