| NPI | 1255696241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX S5579) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116025243) |
| 207W00000X Ophthalmology (Licence: NV DO2100) | |
| 207W00000X Ophthalmology (Licence: CA 20A12899) | |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2020-11-05 |