| NPI | 1285674242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 63674) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2006-01876) |
| 207W00000X Ophthalmology (Licence: FL ME75787) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2022-06-03 |