| NPI | 1851391650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME128222) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX F-2377) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2016-09-21 |