| NPI | 1063075224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 76307) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD481576) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2025-01-16 |