| NPI | 1396491312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 74766) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 32439) |
| Enumeration Date | 2022-02-28 |
| Last Update Date | 2023-07-17 |