| NPI | 1053530931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 18876) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX n5884) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2015-03-10 |