| NPI | 1891141214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX T5634) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 283636) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2022-08-09 |