| NPI | 1538396692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX Q1851) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2013-00434) |
| 208D00000X General Practice (Licence: NE 25760) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2021-12-13 |