| NPI | 1104949841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX P5158) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NE 24539) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2020-05-04 |