| NPI | 1811934805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35090952) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 234064) |
| 207W00000X Ophthalmology (Licence: TN MD0000041297) | |
| 207W00000X Ophthalmology (Licence: MI 4301091260) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2023-11-03 |