| NPI | 1023563277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 13791679-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 4810) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2024-12-12 |