| NPI | 1043302862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 59102) |
| Additional Taxonomies | 207WX0009X Ophthalmology Glaucoma Specialist (Licence: MA 59102) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2019-09-06 |