| NPI | 1700881729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35076236) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301074018) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2024-02-07 |