| NPI | 1689679979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 37967) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 36736-20) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: MN 37967) | |
| 207WX0107X Ophthalmology Retina Specialist (Licence: WI 36736-20) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2021-02-02 |