| NPI | 1851589709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: MN 53792) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 53792) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2019-07-11 |