| NPI | 1063094720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MN 78940) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4351047851) |
| 207W00000X Ophthalmology (Licence: MN 78940) | |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2025-06-27 |