| NPI | 1710323142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MN 63786-20) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 63786-20) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: WI 63786-20) | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2023-03-31 |