| NPI | 1114362688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AL 37065) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 61757) |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2018-05-24 |