| NPI | 1154613099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX T1859) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 944) |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2021-07-06 |