| NPI | 1710988936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35038030S) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 11622) |
| 207W00000X Ophthalmology (Licence: MI 4301060933) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2009-07-15 |