| NPI | 1619400900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35145425) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301503661) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2022-12-14 |