| NPI | 1558593004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 20373) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OK 28337) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2013-07-31 |