| NPI | 1407112881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: MN 64918) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD60668469) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2023-08-31 |