| NPI | 1346575479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.123547) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2010012715) |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2026-05-12 |