| NPI | 1063563823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0009X Ophthalmology Glaucoma Specialist (Licence: ID M-10686) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ID M-10686) |
| 207W00000X Ophthalmology (Licence: OK 24632) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2023-02-21 |