| NPI | 1821056706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 31051) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35044577) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2021-07-14 |