| NPI | 1609074236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 52928) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX M9833) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2020-08-12 |