| NPI | 1720021199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 35605) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35077410) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2011-07-06 |