| NPI | 1053614453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX S2177) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX S2177) |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2019-07-08 |