| NPI | 1609674167 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 83086) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 35009) |
| Enumeration Date | 2025-03-03 |
| Last Update Date | 2026-07-23 |