| NPI | 1184043473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.139513) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 54274) |
| 207W00000X Ophthalmology (Licence: MI 4301115075) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2022-02-14 |