| NPI | 1154398824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MN 45559) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 45559) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2020-05-12 |