| NPI | 1598129702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX T0948) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX MD1983604) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2025-01-30 |