| NPI | 1598940405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD61010671) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NE 24567) |
| 207W00000X Ophthalmology (Licence: TX R8245) | |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2024-08-16 |