| NPI | 1003346081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX T7196) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.141790) |
| 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: TX T7196) | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2023-06-01 |