| NPI | 1588234496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 78765) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2021019305) |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2025-04-14 |