| NPI | 1821157199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX H9725) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35089276) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2015-07-09 |