| NPI | 1356954218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 80356) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 34143) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2025-07-15 |