| NPI | 1720305642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX Q7580) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.123366) |
| Enumeration Date | 2010-05-02 |
| Last Update Date | 2022-07-21 |