| NPI | 1760972236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WV 33892) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.151269) |
| 207W00000X Ophthalmology (Licence: KY 56981) | |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2024-08-12 |