| NPI | 1356780076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 10244495-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2014016539) |
| Enumeration Date | 2013-06-15 |
| Last Update Date | 2022-07-28 |