| NPI | 1891818035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00046132) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35070667) |
| 207W00000X Ophthalmology (Licence: TX Q2062) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2023-01-30 |