| NPI | 1629057666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 47406) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SD 7144) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2023-01-03 |