| NPI | 1962690958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WV 24904) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX BP10029076 Training) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2022-04-12 |