| NPI | 1477533990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 43756) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME130539) |
| 207W00000X Ophthalmology (Licence: AZ 53096) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2020-08-19 |