| NPI | 1366737819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 55061081205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NV 15817) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2022-07-21 |