| NPI | 1689737793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX N1041) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101238505) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2020-09-03 |