| NPI | 1093704751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 53852) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 45197) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2025-11-20 |