| NPI | 1073876397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 65808) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 5101019815) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2019-07-25 |