| NPI | 1740668094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX R0504) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301501696) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2023-10-13 |