| NPI | 1790807998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX S8517) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 258487) |
| 207W00000X Ophthalmology (Licence: NE 24376) | |
| 207W00000X Ophthalmology (Licence: FL ME 107043) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2022-10-14 |