| NPI | 1528006699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 51590) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301072860) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2020-08-14 |