| NPI | 1023471901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 11713637-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OK 32749) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2020-06-08 |