| NPI | 1457612830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 07085) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX Q8049) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2023-09-15 |