| NPI | 1962866632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 62490) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 282966) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2021-08-18 |