| NPI | 1356692818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX 47988) |
| Additional Taxonomies | 282NC2000X General Acute Care Hospital, Children |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2023-07-18 |