| NPI | 1508028523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX P7990) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A108542) |
| 207W00000X Ophthalmology (Licence: TX P7990) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2017-04-06 |