| NPI | 1932360914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 27366) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 57.013147) |
| 207W00000X Ophthalmology (Licence: FL ME109443) | |
| 207W00000X Ophthalmology (Licence: IA 41021) | |
| Enumeration Date | 2008-06-22 |
| Last Update Date | 2014-02-13 |