| NPI | 1740277177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.055064) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 15249) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2020-07-14 |