| NPI | 1548598642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 77686) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.138577) |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2022-04-18 |