| NPI | 1639377096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME136778) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX Q9883) |
| 207W00000X Ophthalmology (Licence: LA MD.202467) | |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2018-09-14 |