| NPI | 1679000103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD475569) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX BP10063331) |
| 208000000X Pediatrics (Licence: PA 208000000) | |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2021-10-29 |