| NPI | 1821280918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 26729) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 097404) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2015-03-12 |