| NPI | 1740741545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 76866) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 11899002-1205) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2024-09-06 |