| NPI | 1245438100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 59935) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2012013480) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2025-10-28 |