| NPI | 1528063526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35062636) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301052712) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2019-11-19 |