| NPI | 1427373075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME138135) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX Q3562) |
| 207W00000X Ophthalmology (Licence: WI 65108) | |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2023-06-26 |