| NPI | 1528063781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 056415) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX Q1386) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2023-06-22 |