| NPI | 1902893241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35047094) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301052580) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2009-03-18 |