| NPI | 1467854240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 72741) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX V5136) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2024-12-05 |