| NPI | 1619141363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX N1239) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AL 30871) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: TX N1239) | |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2018-05-21 |