| NPI | 1275828196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD61027558) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2011015258) |
| 207W00000X Ophthalmology (Licence: TX BP10044383) | |
| 207W00000X Ophthalmology (Licence: AZ 52190) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2020-05-22 |