| NPI | 1154736791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 312342) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX BP10058242) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2019-08-01 |