| NPI | 1619942174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 44159) |
| Additional Taxonomies | 174400000X Specialist (Licence: MN 44159) |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2020-06-18 |