| NPI | 1821292491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX N0152) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX BP2-0018101) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2022-08-19 |