| NPI | 1235423849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX Q7200) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA R-9501) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2022-02-11 |