| NPI | 1982968319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX S1326) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD457225) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2019-06-03 |