| NPI | 1912158627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX R2830) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME119554) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: TX R2830) | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2022-07-21 |