| NPI | 1689092660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX U4814) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101259144) |
| 207W00000X Ophthalmology (Licence: MA 260239) | |
| 207W00000X Ophthalmology (Licence: TX U4814) | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2023-09-18 |