| NPI | 1740388453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D0067554) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35087900) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-09-04 |