| NPI | 1043579733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX R2066) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO DR.0056570) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2022-07-21 |