| NPI | 1891755542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 43335) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME62804) |
| Enumeration Date | 2006-03-26 |
| Last Update Date | 2020-09-28 |