| NPI | 1023436896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX R7122) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MDRE.ML.60469848) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2020-04-24 |