| NPI | 1013147586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301094442) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI 4301094442) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2023-02-28 |