| NPI | 1194795401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 26877) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SC 21922) |
| 207W00000X Ophthalmology (Licence: TX F9622) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2021-09-10 |