| NPI | 1013958958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MT MED-PHYS-LIC-28392) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 29754) |
| 207W00000X Ophthalmology (Licence: NM MD20120733) | |
| 207W00000X Ophthalmology (Licence: WI 35040-20) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2022-07-21 |