| NPI | 1679839872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.155391) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: OH 35.155391) | |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2026-06-30 |