| NPI | 1780720219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME 107766) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 51607) |
| 207W00000X Ophthalmology (Licence: CA A113132) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2021-04-14 |