| NPI | 1912328014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MN 73503) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND RL15730) |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2024-09-04 |