| NPI | 1134325475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 53557) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME 106722) |
| 207W00000X Ophthalmology (Licence: MO 2007013411) | |
| 207W00000X Ophthalmology (Licence: SD 9167) | |
| 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: SD 9167) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2022-05-31 |