| NPI | 1114345725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WV WV27176) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX R6956) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2020-10-23 |