| NPI | 1164740718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX S4807) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301104568) |
| 207W00000X Ophthalmology (Licence: TX BP20040314) | |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2020-07-30 |