| NPI | 1801822242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WV 12735) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 23615) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2010-09-29 |