| NPI | 1699034447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35099930) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY TP601) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2012-08-30 |