| NPI | 1770688376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 33810) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 038324) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MN 033810) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-08-19 |