| NPI | 1598736878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35049681) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301040490) |
| 207W00000X Ophthalmology (Licence: LA L 05806R) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2023-03-07 |