| NPI | 1780635268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX L8680) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NM MD2004-0199) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2023-04-07 |