| NPI | 1912909227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35077543) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD069803L) |
| 207W00000X Ophthalmology (Licence: WV 20115) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2011-12-09 |