| NPI | 1184736464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME107110) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX BP20023396) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-11-13 |