| NPI | 1114907870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2006-00304) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX L8780) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NC 2006-00304) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2023-07-12 |