| NPI | 1962060624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 73253) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-11586) |
| 207W00000X Ophthalmology (Licence: IA R-11586) | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2023-08-02 |