| NPI | 1710023411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101262516) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MD T1822) |
| 207W00000X Ophthalmology (Licence: TX P0530) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: TX p0530) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2019-02-17 |