| NPI | 1932420478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 48406) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35126553) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2015-07-29 |