| NPI | 1063670644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 070070) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY R2010) |
| 207W00000X Ophthalmology (Licence: TX P2974) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2013-09-17 |