| NPI | 1912914201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WV 20149) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35077377) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2008-02-18 |