| NPI | 1215996525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX N5974) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 9900664) |
| 207WX0110X Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist (Licence: TX N5974) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2020-04-27 |