| NPI | 1619534799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 297493) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 63939) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2022-10-04 |