| NPI | 1306057450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ND 13045) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35098474) |
| 207W00000X Ophthalmology (Licence: MI 4301088399) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-06-18 |