| NPI | 1861463093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX P3752) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 22968) |
| 207W00000X Ophthalmology (Licence: GA 63914) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2020-09-30 |