| NPI | 1578211355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 74718) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 32447) |
| Enumeration Date | 2022-03-11 |
| Last Update Date | 2023-07-13 |