| NPI | 1720492630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 34.013335) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 5101021215) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2020-12-04 |