| NPI | 1417582693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 78960) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4351047884) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MN 78960) | |
| Enumeration Date | 2020-03-08 |
| Last Update Date | 2026-05-01 |