NPI | 1518340181 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC 86195) |
Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 65213) |
207W00000X Ophthalmology (Licence: OH 57.027461) | |
Enumeration Date | 2015-07-01 |
Last Update Date | 2025-04-22 |