| NPI | 1982053872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.138669) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301110304) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2022-08-24 |