| NPI | 1285921924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 57335) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 61500-20) |
| 207WX0009X Ophthalmology Glaucoma Specialist (Licence: WI 61500-20) | |
| 207WX0009X Ophthalmology Glaucoma Specialist (Licence: MN 57335) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2021-02-02 |