| NPI | 1730355116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 252341) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.098787) |
| 207W00000X Ophthalmology (Licence: KY 45126) | |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2014-07-17 |