| NPI | 1639173669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX H2575) |
| Additional Taxonomies | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: TX H2575) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2022-11-02 |