| NPI | 1073048963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA 16655) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: CA 16655) | |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2023-07-14 |