| NPI | 1538328489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2012003514) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX N1182) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2020-06-23 |