| NPI | 1780753707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34-002236) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 34-002236) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2012-05-18 |