| NPI | 1053794784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX 47530) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD D87935) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2021-11-08 |