| NPI | 1184689101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 20875) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 27830) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2016-04-05 |