| NPI | 1609166768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MN 63502) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 63502) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2021-12-22 |