| NPI | 1013449388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 56353) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 69035) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2022-09-07 |