| NPI | 1285619684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: MN 27963) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 27963) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2021-03-11 |