| NPI | 1821093535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301102751) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 049666) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2013-10-02 |