| NPI | 1053750794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME135382) |
| Additional Taxonomies | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: FL ME135382) |
| 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: TX R2382) | |
| Enumeration Date | 2013-06-16 |
| Last Update Date | 2018-10-05 |