| NPI | 1568808764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 79622) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX R1610) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2022-07-27 |