| NPI | 1023542495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: TX T5963) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX T5963) |
| 207W00000X Ophthalmology (Licence: UT 12153870-1205) | |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2022-09-13 |