| NPI | 1689671638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 262669-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WY 6778A) |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2022-07-21 |