| NPI | 1518340181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 65213) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 57.027461) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2020-09-23 |