| NPI | 1982659934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35-038614) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 29018) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2009-03-30 |