| NPI | 1275948275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 63750) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7191) |
| 207W00000X Ophthalmology (Licence: MO 2015017084) | |
| 207W00000X Ophthalmology (Licence: WI 69145) | |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2023-03-13 |