| NPI | 1972552628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0110X Ophthalmology Pediatric Ophthalmology and Strabismus Specialist (Licence: MI 4301047600) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 047600) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2020-04-21 |