| NPI | 1174054860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX T5827) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OK 6361) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2022-10-06 |