| NPI | 1417093980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX N2506) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD P21367) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-11-13 |