| NPI | 1689991747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 8967732-1205) |
| Additional Taxonomies | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: NC 2016-01582) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2019-10-05 |