| NPI | 1780611269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO 46109) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35-05-3085) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2023-06-13 |