| NPI | 1386087443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301116922) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX R2354) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2020-12-16 |