| NPI | 1003046830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX P6433) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 241707) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2017-05-01 |