| NPI | 1568786176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX Q8731) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AL 33313) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NM MD2016-0494) | |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2020-06-17 |