| NPI | 1164427597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G15339) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 154949-1205) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2023-03-07 |